Exercise and Nutrition in Pregnancy

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Exercise and Nutrition in Pregnancy

• Gowri Reddy Rocco, MD
• Family Medicine Womens Health

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Exercise recommendations during Pregnancy-
Introduction

• In the past, women were told to significantly
  increase their caloric intake and decrease their
  physical activity during pregnancy.
• Thus, pregnancy became a large contributor to the
  present obesity epidemic.
• Currently, experts recommend that pregnant women
  continue and maintain an active lifestyle during
  their pregnancy.
• Exercise does not increase the risk of
  miscarriage.

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Exercise Regimens for Pregnant Females

• A thorough medical exam/evaluation should be
  conducted prior to recommending an exercise
  program.
• This is done at routine prenatal visits and an
  exercise prescription is usually recommended at
  this time.

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Pre-exercise medical screening

• Overall health, obstetrical history and medical
  risks are reviewed.
• Considered factors include
• Age
• General physical condition
• Exercise history
• Risk factors for coronary heart disease
• Orthopedic history and musculoskeletal risks
• Medication use
• History of pulmonary disease
• Anticipated type of exercise
• Handicaps or disabilities
• Current and past obstetric history

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Pre-exercise medical screening

• Women in good health should be encouraged to
  engage in regular, moderate intensity physical
  activity during a normal, uncomplicated
  pregnancy.
• Pregnant women with diabetes, morbid obesity, or
  hypertension should be counseled on an individual
  basis.
• Contraindications to exercise
• Preexisting or developing medical conditions
• These women should be closely monitored.

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Exercise Prescription

• Exercise intensity should start light to moderate
  and should gradually increase.
• There is no data to support health benefits from
  prescribing strenuous exercise to pregnant women.
• A meta-analysis of exercise and pregnancy
  reported an exercise program for an average of 43
  minutes 3 times a week at a
  heart rate 144 bpm was not associated with
  adverse effects on maternal weight gain, birth
  wt., length of gestation, length of labor, or
  APGAR scores in normal pregnancies.

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Benefits of Exercise

• Pregnancy usually leaves women feeling tired,
  exercise gives you more energy to make through
  the day.
• Exercise allows you to sleep better.
• Improves your mood, lessens mood swings, improves
  your self image, and gives you some sense of
  control.
• Prepares you for childbirth. Studies show shorter
  labor, fewer medical interventions, and less
  exhaustion during labor.
• Easier to lose the weight after the baby is born.

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Recommendations

• Both ACOG ( American College of Obstetrics and
  Gynecologists) and ACSM (American College of
  Sports Medicine) recommends at least 30 minutes
  of physical exertion for most days of the week.
• As your pregnancy progresses, your center of
  balance shifts, making falls more likely.
  Participating in activities such as swimming,
  walking or low impact aerobics do not put you at
  additional risk to slip or fall.
• Keep your heart rate under 140 bpm and avoid
  overheating, especially in your first trimester
  and stay well hydrated.

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Recommended exercises

• Kegel women have easier births, minimize bladder
  leaks and hemorrhoids. Please refer to handout.
• Walking Start slowly, stretch before you begin.
  Wear good shoes to decrease risk of falling.
• Swimming safest exercise for pregnant women,
  because doesnt add extra weight or stress to
  your joints.
• Running and Jogging usually if your in a habit
  of running before pregnancy, you can continue
  running. Make sure youre well hydrated and
  avoid over-heating and wear good shoes.
• Bicycling and Stair climbing machines Safe in
  the beginning, but as your center of gravity is
  shifting, you have a greater risk of falling.
• Yoga Relieves stress and pressure on your body.
  Avoid laying on your back for extended periods
  of time and try not to overstretch.
• Aerobics/ Dance Avoid spinning, leaping and
  jumping.

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Exercises to Avoid

• Activities with high risk of falling or those
  with a high risk of abdominal trauma are not
  recommended
• Skiing
• Water skiing
• Horseback riding
• Scuba diving
• Contact sports- ice hockey, soccer,
  basketball

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When you exercise

• Dont wear tight clothes
• Wear a good sports bra
• Wear comfortable shoes that give strong ankle and
  arch support
• Breathe deeply
• Drink lots of water
• Keep your heart rate under 140 bpm
• Avoid jerking motions
• Avoid laying on your back for extended periods of
  time
• Avoid exercise in extremely hot weather
• Stop exercising if you have any vaginal bleeding,
  faintness, shortness of breath, contractions or
  nauseous feelings.

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Benefits of Exercise during Pregnancy

• Retrospective data suggest that exercise may
• prevent gestational diabetes
• reduce the risk of developing preeclampsia
• prevent excessive weight gain during pregnancy
• Gaining weight at a steady rate can lower your
  chances of having
• Hemorrhoids
• Varicose veins
• Stretch marks
• Backache
• Fatigue
• Indigestion
• And shortness of breath during pregnancy

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Exercise in Postpartum

• May start as early as 2 weeks or at 6 weeks after
  delivery.
• Modest weight reduction while nursing is safe and
  does not compromise neonatal weight gain.
• Nursing women should consider feeding their
  infants before exercising to avoid the discomfort
  of engorged breasts and also avoid the problems
  associated with increased acidity of milk
  secondary to any build-up of lactic acid.
• Exercise postpartum is also associated with a
  decreased frequency of postpartum depression.

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Nutrition in Pregnancy- Intro

• Pregnancy is the one time in your life when your
  eating habits directly affect another person.
• A nutritious, well-balanced eating plan will give
  your baby a strong start in life.

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Nutrition in Pregnancy

• The key components of a health lifestyle during
  pregnancy include
• Appropriate weight gain
• Appropriate physical activity
• Consuming appropriate amounts of food to allow
  adequate, but not excessive, maternal weight gain
• Appropriate vitamin and mineral supplementation
• Avoidance of alcohol
• Avoidance of tobacco, drug use and other harmful
  substances

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Avoidance of food borne illnesses

• Food borne illness have adverse effects to mother
  and fetus, especially Toxoplasma and Listeria.
• To avoid the risk of food borne illnesses, it is
  important to
• Frequently wash hands
• Consume only meats, fish, poultry that are fully
  cooked
• Avoid unpasteurized dairy products
• Thoroughly rinse fresh fruits and vegetables
  under running water before eating
• Hands, food prep surfaces, cutting boards,
  utensils that come in contact with raw meat,
  eggs, poultry, fish should be washed well with
  hot, soapy water

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Pregnancy weight gain

• How much weight a woman should gain all depends
  on her prepregnancy weight.
• Underweight women with low weight gain during
  pregnancy appear to be at higher risk for having
  a low birth wt. Infant, preterm birth and
  recurrent preterm birth.
• Obese women are at increased risk of having a
  large for gestational age infant, post term
  birth, and other birthing complications.

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How much total weight should I gain?

• This all depends on your prepregnancy wt
• 25-37 pounds for normal weight women
• BMIlt19.8
• 28-40 pounds for underweight women
• BMI 19.2-26
• 15-25 pounds for overweight women
• BMI 26-29
• 15 pounds for obese women
• BMIgt29

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Where does the extra weight go?

• Baby 7-8 pds
• Placenta 1-2 pds
• Amniotic Fluid 2 pds
• Uterus 2 pds
• Maternal breast tissue 2 pds
• Maternal blood 4 pds
• Your blood volume will have increased as much as
  60
• Fluids in maternal tissue 4 pds
• Maternal fat and nutrient stores 7 pds
• Nutrients stored for breastfeeding the baby after
  delivery

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Rate of weight gain

• Also depends on prepregnancy weight and goal
  should be to keep weight gain as steady as
  possible
• Healthy weight before pregnancy
• 3-5 pds during the first trimester
• 1-2 pds/ week second and third trimester
• Underweight before pregnancy
• 5-6 pds or more first trimester, depending on
  medical eval
• 1-2 pds/week second and third trimester
• Overweight before pregnancy
• 1-2 pds first trimester
• 1 pd/week during last six months

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Risks of gaining too much weight

• These are potential medical problems with gaining
  too much weight
• Gestational diabetes- high blood sugar
• Backaches
• Preeclempsia- high blood pressure
• Leg pain
• Increased fatigue
• Varicose veins
• Increased risk of cesarean delivery

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Recommended Daily Allowances (RDAs)

• 3-4 servings of fruits and vegetables
• 9 servings of whole-grain or enriched bread,
  cereal, rice or pasta for energy
• 3 servings of milk, yogurt and cheese for calcium
• 3 servings of meat, poultry, fish, eggs, nuts,
  dried beans and peas for protein

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RDAs

• Calories- recommended intake is increase in daily
  caloric intake
• 340 kcal/day in the second trimester
• 452 kcal/day in the third trimester
• Protein- recommended intake is 75-100 grams/day.
• This means 2-3 servings of meat (3 ounces-deck of
  cards)
• Animal foods are considered complete or
  high-quality proteins b/c they contain all the 9
  essential amino acids.
• Plant based foods are incomplete, and can be
  fortified with soy products and increase of dairy
  products.
• Carbohydrate- recommended intake is 175 g/day, up
  from 130 g/day in nonpreg women
• Usually 8-9 servings of whole grain, enriched
  breads and pastas
• Iron- recommended intake is 30 g/day, almost
  double.
• This means 2-3 servings of green leafy
  vegetables, 3 servings of whole grains, and 2-3
  servings of lean protein.
• Necessary for fetal/placental development and to
  expand the maternal blood volume.
• Calcium- recommended intake is 1000 mg/day.
• For fetal skeletal development, especially in
  third trimester.
• This means 3-4 servings of dairy products.
• Folic acid- recommended 600-800 mcg daily.
• Preconception recommendation to all fertile
  females of 400mcg, because the neural tube closes
  between 18-26 days after conception so folic acid
  supplementation after the diagnosis of pregnancy
  is usually too late to reduce the effects of
  neural tube defects.

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Additional benefits

• Omega 3 Fish Oils, consisting of DHA
  (Docosahexaenoic acid), appear to be essential
  for early brain development during gestation and
  infancy.
• Recommended dose is between 200-400mg/day
• Offspring of mothers who took Omega-3 Fish Oils
  during pregnancy and lactation scored higher on
  cognitive tests.
• These supplements also have been to show to
• Improve visual acuity
• Decrease the risk of allergic disorders
• Improve neurological, immunological and physical
  development

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Dietary Restrictions

• Fish
• 2 or more servings/week associated with
  improvement with fetal brain development,
  however, it is very important not to eat fish
  containing mercury, which causes delayed
  development and brain damage to the child and
  mother.
• Avoid eating any shark, king mackerel, tilefish,
  tuna
• Low in mercury fish are shrimp, canned light
  tuna, wild Alaskan tuna, catfish. Canned
  albacore white tuna has more mercury than canned
  light tuna.

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Dietary Restrictions

• Caffeine
• A stimulant and a diuretic, this leads to
  increased BP, HR and reduction in body fluids
  leading to dehydration.
• Caffeine also crosses the placenta to your baby,
  you are able to metabolize it, however, your baby
  is not.
• Found in coffee, tea, chocolate, soda, some OTC
  meds that relieve headaches.
• Studies have reported an association between high
  levels of caffeine consumption and risk of
  miscarriages, decreased birth weight, and late
  fetal death.
• Restriction of caffeine consumption to 1-2 cups
  or less than 300mg/day seems prudent.
• The less caffeine you consume the better.
• Artificial sweeteners
• No evidence of use during pregnancy increases
  birth defects, however, advised to avoid if
  possible.

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Breastfeeding Nutrition

• Women breastfeeding should increase their caloric
  intake by 300-500kcal above prepregnancy levels
• Should also consume 1000mg/day of Calcium
• Caloric demand of breastfeeding is estimated at
  640kcal/day, however, this depends on maternal
  weight.

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THANK YOU!!!

• ANY QUESTIONS?